471 NAC 23-005. BILLING AND PAYMENT FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SERVICES

005. BILLING AND PAYMENT FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SERVICES. 005.01 GENERAL BILLING REQUIREMENTS. Providers must comply with all applicable billing requirements codified in these regulations . 005.02 BILLING INSTRUCTIONS. The provider must bill Nebraska Medicaid, using the appropriate claim form or electronic format. 005.03 USUAL AND CUSTOMARY CHARGE. The provider, or their authorized agent, must submit the provider's usual and customary charge for services rendered. 005.04 MEDICAL NECESSITY DOCUMENTATION. The provider must list the following information when submitting a claim for speech-language pathology or audiology services: (1) The date of illness or injury onset; (2) The date speech-language pathology or audiology plan was established; (3) The date speech-language pathology or audiology services started; and (4) The number of speech-language pathology or audiology visits from onset. 005.05 HOME HEALTH AGENCY. Services offered through home health agencies require prior authorization. 005.06 GENERAL PAYMENT REQUIREMENTS. Nebraska Medicaid will reimburse the provider for services rendered in accordance with these regulations . 005.07 PAYMENT FOR INDIVIDUAL PROVIDERS. Claims are paid by Nebraska Medicaid for covered speech-language pathology and audiology services in the amount equal to the lesser of: (1) The provider's submitted charge; or (2) The allowable amount for that procedure code in the Nebraska Medicaid Practitioner Fee Schedule in effect for that date of service.